3 Things You Need to Know About Alcohol and Breastfeeding

We're talking about drinking alcohol while your breastfeeding. While the message about drinking while you're pregnant is pretty clear–it can be seriously harmful for babies–the message about booze while breastfeeding is less precise.

Decker got major flack, she told People this week, for drinking a glass of wine while breastfeeding five-month-old Forrest Bradley–a moment which was immortalized in a photo last month. The case echoes another from 2014, when Tasha Adams, a 28-year-old mother of three was arrested for allegedly endangering the welfare of her then-six-month-old daughter after drinking while breastfeeding at an Arkansas restaurant. The charges were eventually dropped; drinking while nursing isn’t illegal in Arkansas.

Drinking while nursing may not be illegal, but experts say large amounts of alcohol can be harmful for a breastfeeding baby. So are smaller amounts safe? And if so, how much is too much? That's less clear.

"It's definitely gray," says Catherine Herway, MD, a maternal fetal medicine specialist with CrystalRun Healthcare in Middletown, New York. There just aren't enough good-quality studies to give us the full picture, she adds.

Mothers of newborns less than three months old should be extra careful about drinking, as the baby's brain is still developing and very vulnerable, says Beth Conover, a nurse practitioner at the University of Nebraska Medical Center in Omaha.

Studies have also shown that when there's alcohol in breast milk, babies drink less and may not grow as well, Dr. Herway says. One study found that when mothers had more than one drink daily during breastfeeding, their babies had impaired motor development (but not mental development) at age 1, though a later study did not duplicate that finding. A more recent study, though, did find mental development issues in children who had been exposed to alcohol through breast milk: At ages 6 and 7, these children did not perform as well as other children on reasoning tests.

The American Academy of Pediatrics (AAP) recommends breastfeeding mothers limit their alcohol intake and refrain from drinking two hours or less before breastfeeding. (It also discourages smoking as it is linked to sudden infant death syndrome and increased allergy incidence.)

And it’s an old wive’s tale that a small amount of alcohol can actually help milk letdown, or the release of milk. The AAP says alcohol is not a galactagogue, meaning it doesn’t improve milk production or milk letdown. However, several studies have shown that drinking beer can increase levels of the hormone prolactin, which helps in the creation of breast milk. Researchers note that polysaccharides from barley and hops are responsible—so non-alcoholic beer has the same effect.

That said, there are ways to drink responsibly without endangering your baby. Here are three things you need to know about alcohol and nursing.

Less is more

Breastfeeding or not, women and men should not drink more than the amounts recommended by leading health organizations, Conover says. For women, that’s one drink per day.

The AAP says that while alcohol intake should be limited, an occasional drink is acceptable. Specifically, the AAP says nursing moms should have no more than 0.5 grams of alcohol per kilogram of body weight—which for a 60-kilogram mother (about 130 pounds), is about 2 ounces of liquor, an eight-ounce glass of wine, or two beers. These measurements are slightly larger than "standard" drink sizes of about 1.5 ounces of liquor, 5 ounces of wine, or 12 ounces of beer. The AAP's recommendation is based on what's safe for the baby, not the amount that's beneficial for your long-term health.

Timing is everything

It's probably best not to breastfeed your baby as you’re drinking or right after drinking. "If a mom is going to drink alcohol, she should wait at least three to four hours until breastfeeding the baby," Dr. Herway says. (The AAP says to wait a minimum of two hours.)

"The amount of alcohol in breast milk is very similar to the amount in the woman's blood and alcohol is a fast-acting drug," explains Conover. "It peaks pretty fast after you drink... It moves in and out of milk."

Alcohol could take longer to peak in some women, so pay attention to how you feel in addition to how long it’s been since you finished your drink. "If you're still feeling woozy, it's like the canary in the coal mine," says Conover. "The alcohol level is [still] too high in the blood stream and in the breast milk."

Plan ahead when possible

If you know you're going to drink and your baby will need to eat not long after, make sure you have some stored breast milk or formula ready to go, says Conover. If you do bottle-feed your baby after having a drink, you can "pump and dump" to alleviate breast pain that may result from skipping a feeding.

"We get a lot of calls [from mothers] on St. Patrick's Day and New Year's Eve," Conover says. "They're calling because they'd like to still have a life and they want to take good care of their babies. They're responsible."

Decker stressed to People that she, too, is responsible–and unapologetic. “I know I’m a great mother, there’s not one doubt in my mind. I know that I take care of my babies, I know that they feel loved and they feel happy. So if I want to have a cocktail to celebrate my husband doing something great in his work, I’m going to, and I can still breastfeed.”